Prepositioning Antibiotics for Anthrax (2012) / Chapter Skim
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3 Current Dispensing Strategies for Medical Countermeasures for Anthrax
3 Current Dispensing Strategies for Medical Countermeasures for Anthrax
Pages 69-92
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From page 69... ...
The chapter then reviews concerns about the current dispensing system, as well as salient legal and regulatory issues. CURRENT MCM DISTRIBUTION AND DISPENSING SYSTEM Figure 3-1 depicts the basic MCM distribution and dispensing system currently in place in the United States.
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From page 70... ...
Receive/Stage/Store Local Receiving Center Push Strategies PODs (e.g., Postal model) Open and Closed End-Users End-Users POST-EVENT FIGURE 3-1 Basic medical countermeasures (MCM)
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From page 71... ...
, is a national repository of medicine and medical supplies that can be rapidly deployed in the event of a public health emergency that is severe enough to exhaust local supplies (CDC, 2010a)
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From page 72... ...
The contents of the SNS are determined by HHS and CDC based on such factors as current threats, the medical vulnerability of the civilian population to those threats, currently available medical products, and the ability to disseminate those products (CDC, 2010a)
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From page 73... ...
. This improvement has been achieved through increased staffing, the purchase of key equipment, strengthening of partnerships, development of detailed MCM dispensing plans and streamlined dispensing models, and training and exercising.
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Many state and local health agencies currently are working to expand the number of push or closed POD sites in their dispensing plans. Points of Dispensing Most current state and local strategies rely on the POD model for the dispensing of MCM to the public.
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The nonmedical POD offers greater efficiency than the medical POD, but as it does not offer patients individual medical assessments, its use may necessitate altered standards of care and suspension of certain practice requirements. Moreover, while the nonmedical POD model leaves professional medical staff free to tend to victims of an incident, staffing issues still arise as some jurisdictions rely heavily on volunteers.
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From page 76... ...
76 PREPOSITIONING ANTIBIOTICS FOR ANTHRAX BOX 3-1 Head-of-Household Point of Dispensing (POD) E xercise in Philadelphia Exercise • T he exercise involved an inhalation anthrax exposure scenario.
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From page 77... ...
Beyond the Georgia example, data are sparse on the prevalence of closed PODs as a component of state and local plans for dispensing MCM. Closed PODs and workplace caches are discussed in greater detail in Chapter 4.
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From page 78... ...
. Virginia also has tested a push dispensing model that involves using public school buses carrying Medical Reserve Corps volunteers and city employees to deliver MCM to residences (NACCHO, 2008)
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It specifies the intended use and effective time period of the MCM to be dispensed, the population for which and geographic area in which MCM dispensing is allowed, and which stockpiles of MCM are granted liability protection under the Public Readiness and Emergency Preparedness (PREP)
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From page 80... ...
Postal Service medical countermeasures dispensing model for U.S. cities to respond to a large-scale biological attack, with anthrax as the primary threat consideration.
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From page 81... ...
. Beyond these security concerns, the postal model as piloted raises logistical overhead issues and concerns about a lack of flexibility that could impede its incorporation into preexisting local MCM dispensing plans and/or divert MCM and planning and response efforts from POD operations.5 The Role of Clinicians and First Responders Clinicians and first responders are important to many aspects of a response to a bioterrorism attack, from detection to mass prophylaxis.
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From page 82... ...
. The Executive Order mandating a national USPS MCM dispensing model was issued based on the need to supplement state and local capabilities (Obama, 2010)
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From page 83... ...
about staffing during a more sudden response, such as would be required for an anthrax attack. Communication/Public Education In the event of a public health emergency, effective communication is critical to ensure that the public knows when and where to go to obtain MCM, regardless of which dispensing mechanisms are employed.
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Survey data and evidence from the 2001 anthrax attack suggest adherence is likely to be quite poor. Following that attack, a mass anthrax postexposure prophylaxis campaign was implemented in six areas where exposures had been confirmed.
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From page 85... ...
. LEGAL AND REGULATORY ISSUES IN MCM DISPENSING This section highlights the legal and regulatory issues of primary concern to MCM dispensing, including prescription laws, EUAs, liability and the Public Readiness and Emergency Preparedness (PREP)
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From page 86... ...
It specifies the intended use and effective time period of the MCM to be dispensed, the population for which and geographic area in which MCM dispensing is allowed, and which stockpiles of MCM are granted liability protection under the PREP Act (see below)
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From page 87... ...
This provision extends PREP Act protection to postal carriers, for example, operating under a postal dispensing program (Binzer, 2008; HHS, 2008)
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stockpiles. SUMMARY Current MCM distribution plans rely on distribution from the federally managed SNS and state and local stockpiles.
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From page 89... ...
Concerns about the current dispensing system have led to the exploration and development of other dispensing strategies, including the postal model; enhanced involvement by the private sector; and other novel strategies, such as Virginia's efforts to use school buses to dispense MCM to the public. These concerns also have led to increased interest in prepositioning strategies, which are examined in the next chapter.
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From page 90... ...
2008. Dispensing medical countermeasures for public health emergencies: Workshop summary.
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From page 91... ...
Slides presented at the Institute of Medicine Public Workshop for the Committee on Prepositioned Medical Countermeasures for the Public, Washington, DC, http://iom.edu/~/media/Session%206%20SadoveLegalRegulatory%20 Perspective.pdf (accessed March 23, 2011)
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From page 92... ...
Technical Report TR-640-CDC. Santa Monica, CA: RAND Corporation, http://www.rand.org/ pubs/technical_reports/TR640.html (accessed February 16, 2011)
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